RESUMEN
OBJECTIVE: Nasal-breathing impairment has been described as a possible determinant of maxillofacial development in children with adenoids/tonsils hypertrophy. However little is known about the possible influence of nasal septum deviation on craniofacial growth in childhood. We conducted a multicenter cephalometric study to compare skeletal and dental features in children with chronic nasal-breathing obstruction secondary to nasal septum deviation and nose-breathing controls. METHODS: Ninety-eight children (59M, 39F; mean age 8.8 years; age range 7-12 years) with obligate mouth-breathing secondary to nasal septum deviation (group 1) and 98 age- and sex-matched nasal-breathing controls (group 2) were evaluated. Nasal-breathing function was assessed in all patients with clinical history, ENT instrumental examination and anterior active rhinomanometry. Cephalometric parameters were recorded in all subjects. RESULTS: Patients of group 1 showed a statistically significant increase of upper anterior facial height (N-palatal plane) and total anterior facial height (N-Me) with regards to group 2. The angular relationships of the sella-nasion, palatal, and occlusal planes to the mandibular plane were greater in group 1 in comparison to controls. The gonial angle (Ar-Go-Me), palatal height and overjet were significantly higher in the mouth-breathing group. A significantly retrognatic position of the maxilla and mandible was recorded in group 1 in comparison to group 2. Most mouth-breathing children showed class II malocclusion, while the majority of control subjects presented normal occlusion. The prevalence of cross-bite was higher in group 1 with respect to controls (p=0.02). CONCLUSION: Children with obligate mouth-breathing due to nasal septum deviations show facial and dental anomalies in comparison to nose-breathing controls. Possible physiologic explanations of our findings are reported.
Asunto(s)
Desarrollo Maxilofacial/fisiología , Respiración por la Boca/fisiopatología , Obstrucción Nasal/fisiopatología , Tabique Nasal/anomalías , Estudios de Casos y Controles , Cefalometría , Niño , Estudios de Cohortes , Femenino , Humanos , Masculino , Respiración por la Boca/etiología , Obstrucción Nasal/etiología , Factores de RiesgoRESUMEN
BACKGROUND: The importance and technical difficulties of septal surgery often are underestimated. Although septoplasty is among the most common procedures in nasal surgery, it is poorly taught and developed. METHODS: Septoplasty was performed for 1,035 consecutive white patients (789 males and 246 females) with a mean age of 35.7 years (range, 6-62 years) using a new personal surgical technique. Septal surgery was associated with functional endoscopic sinus surgery (FESS) in 157 cases and rhinoplasty in 416 cases. Preoperative otorhinolaryngologic examination using flexible nasal endoscopy,anterior active rhinometry (AAR), and occasional computed tomography of the paranasal sinuses was performed.Postoperative AAR was carried out. Septoplasty operative time was measured. RESULTS: A significant reduction in nasal breathing resistances with respect to preoperative conditions was found in 1,017 patients (98%) after AAR (p\0.001). No septal perforation, nasal infection, or bleeding was noticed postoperatively.Three cases of turbino septal synechiae were observed. The mean septoplasty operative time was 13.83 ± 4.22 min (range, 8-31 min). A short learning curve (20 septoplasty procedures) for this new septoplasty technique was found. CONCLUSION: The proposed septoplasty technique is an effective and rapid procedure for the correction of septal deviations in both adults and children. Reproducible and easily learned, this technique can be associated with other surgical procedures such as FESS and rhinoplasty.